My first three-hour session was Tuesday (Sept. 7) and it was taught by Bert Nash CEO David Johnson and Tracy Kihm, finance director.

Ten people are in my class, and some members shared the reasons they decided to take the class; among them were to help friends, family, co-workers and themselves. For me, it’s for all of those reasons and to help me become a better health reporter.

The first session was an overall introduction to mental health, and then it focused on depression. We learned the symptoms and what causes depression and then, of course, how to help.

The class included a game, role play, a video and discussion. Time flew by.

Depression

What’s the difference between feeling blue and a major depressive disorder? A major depressive disorder lasts for at least two weeks and affects a person’s ability to work, to carry out daily activities, and to have satisfying personal relationships. About 7 percent of U.S. adults will experience major depression in any given year.

(Data and statistics are from the class instructors and a manual that we were given, “Mental Health First Aid USA” by Betty Kitchener, Anthony Jorm and Claire Kelly.)

Causes include: job loss, breakup of a relationship, death of loved one, childbirth, poverty, bullying, and/or being a victim of a crime.

Symptoms include: lack of energy, sleeping too much or not being able to sleep, change in eating habits, and/or unusually sad mood.

The main crises associated with major depression:

• The person has suicidal thoughts and behaviors.

• The person is engaging in nonsuicidal self-injury. (We will learn about this in session four).

• About 35,000 Americans die by suicide each year, or one person every 15 minutes.

• Males take their own lives at nearly four times the rate of females, but women attempt suicide about two to three times as often as men.

• Among males, adults 85 and older have the highest rate of suicide.

• Among females, those in their 40s and 50s have the highest rate of suicide.

• About 87 percent of people who complete suicide have a mental health disorder.

How to help

Like other first aid classes, there is a mnemonic — or memory device — for the action plan. For example, many people know ABC (Airway, Breathing and Circulation) to help someone who is injured or ill. For Mental Health First Aid, it is ALGEE:

• A — Assess for risk of suicide or harm.

• L — Listen nonjudgmentally.

• G — Give reassurance and information.

• E — Encourage appropriate professional help.

• E — Encourage self-help and other support strategies.

We learned that if we suspect someone may be at risk of suicide, it is important to directly ask about suicidal thoughts. For example, “Are you having thoughts of suicide?” or “Are you thinking about killing yourself?”

The instructors emphasized to ask the question without dread or without expressing negative judgment. For example, never say, “You aren’t thinking of suicide, are you?”

Asking the question is never easy, they said, but very important. We did some role play with a partner, and that was difficult.

On Wednesday night, I covered a national expert’s presentation on suicide prevention. About 30 people were in the audience. Several revealed that they were there to help family and friends. One woman said she had attempted suicide and was there to help herself and family.

David Litts, director of Science and Policy at the national Suicide Prevention Resource Center, gives a presentation "Preventing the Suicide of Someone You Know, Someone You Love," Wednesday, Sept. 8, 2010, at Lawrence Memorial Hospital.
by Nick Krug

After the presentation, I interviewed Marcia Epstein, executive director of Headquarters Counseling Center in Lawrence, who said 10 people had died by suicide in Douglas County during the first five months of this year. She said one Kansan dies every day.

Hearing the local stories and statistics brought this cause much closer to home. On Friday, I lit two candles in recognition of International Suicide Prevention Day. I thought about those who had died by suicide that I knew (all men, but one):

• Two high school students while I was in junior high school.

• Two middle-aged Kansas farmers/ranchers.

• A college student who lived in an apartment complex next to my boyfriend (now husband).

• A friend of my husband’s grandfather.

• A friend’s brother.

I also thought about Mental Health First Aid, and how grateful I am for the class.

SESSION 2: Second Mental Health First Aid session covers self-injury, anxiety and more

There was more discussion this session among the 10 members in my class. We also watched a video and played a game.

Self-injury

I learned that self-harm:

• is not a mental illness. It is a behavior and often a symptom of mental illness, such as depression, psychosis or borderline personality disorder.

• isn’t a failed suicide attempt. The intention is to harm self, not kill self.

• is more than just cutting, burning and tearing skin. Other forms include excessive exercise, pinching, increased drinking, overdose with nonfatal intention, sabotaging good relationships, hair pulling, and staying with people who mistreat you.

A 2006 survey of college students found that 17 percent had engaged in self-injury, according to Mental Health First Aid USA. A 2005 survey of high school students found 20 percent of girls and 9 percent of boys had engaged in self-harm.

Kihm said this was the hardest behavior for her to understand, and I don’t think she is alone.

Here are some of the reasons people do it:

• escape from unbearable anguish.

• change the behavior of others.

• escape from a situation.

• show desperation to others.

• “get back at” other people or make them feel guilty.

• gain relief of tension.

• seek attention or help.

Anxiety

Everyone experiences anxiety at some time. It can be useful in helping avoid dangerous situations or motivating people to solve everyday problems. I get anxious sometimes when I have to interview people or talk before a group of people.

An anxiety disorder differs from normal anxiety because it’s:

• more intense.

• long lasting.

• interferes with work, activities and relationships.

About 18 percent of U.S. adults have an anxiety disorder in any given year.

Anxiety disorders tend to begin before adulthood. The median age of onset is 11 years. They are more common in females than in males.

Roach Smith said Bert Nash has a clinic that specifically addresses anxiety, and she said treatment can be fairly quick.

One of the common risk factors is a panic attack, and the symptoms are very similar to the symptoms of a heart attack, among them: chest pain, rapid heartbeat, shortness of breath, dizziness, sweating, nausea and shaking.

Panic attacks may have happened before and the person might know the difference.

• If the person is suffering four weeks after trauma, they may need professional help.

Other tidbits

Roach Smith covered how to listen nonjudgmentally. This was a nice refresher to take in and apply to everyday life and relationships.

The group asked about what types of professional services are available for mental illness. Roach Smith said they include talk therapies, medication, and support groups.

Someone also asked about the costs associated with getting help. What if the person can’t pay?

Roach Smith said Bert Nash accepts insurance and charges on a sliding scale based on household income. The full fee is $125 per hour, and is charged to households that earn more than $45,000. She added that most people are treated in five sessions.

Class members agreed that the cost for professional help far outweighed the possible consequences of going untreated: loss of job, loss of housing, emergency room visit, hospital stay, suicide.

About two-thirds of the time was spent on psychosis because it’s what most people think of when they hear someone has a mental illness. But, only 1 percent of Americans suffer from it.

Psychosis

People experiencing early stages of psychosis often go undiagnosed for a year or more. This is because it often begins in late adolescence or early adulthood and the early signs and symptoms involve behaviors and emotions that are common in this age group, such as depression, anxiety, irritability, reduced energy, difficulties with concentration or attention, sleep disturbances and social isolation.

• About one-third of people will only have one episode and fully recover.

• About 5 percent die by suicide.

Another common disorder is bipolar disorder. I was surprised by how many people in my class knew of someone who suffered from this illness. They talked about how people jokingly say to their friends, “He is so bipolar.” But, it’s not funny.

Class discussion also focused on how people tend to AVOID people with psychosis because they often are portrayed as unpredictable, violent or dangerous; however, the vast majority are not. Only 10 percent of violence in society is due to mental illness.

During class, we watched a video of two women who tried to help someone who was suffering a psychotic episode. It illustrated the importance of knowing what to say to someone. One woman was able to help, while the other woman made the situation worse.

A class exercise helped us understand what it might be like to hear voices, and how difficult it could be to carry a conversation.

Substance abuse

It is considered a disorder if:

• There is a dependence on alcohol or other drugs.

• Use leads to work, school, home, health or legal problems.

Substance abuse often starts as pleasure, but ends up being about relief from pain. Kihm said people can be judgmental about those with a substance disorder. To help her understand what a person might be going through, she thinks about how hard it would be for her to give up certain foods.

Did you know?

• About 3.8 percent of U.S. adults have a substance use disorder with the majority involving alcohol.

• 50 percent of people develop the disorder by age 20, and 75 percent develop it by age 27.

• People with a mood or anxiety disorder are two to three times more likely to have a substance abuse disorder.

• Of people who die by suicide, 26 percent had a substance abuse disorder.

• Only 38 percent of people with a substance abuse disorder in the past year received such help.

How much alcohol is considered too much?

• For men — More than four drinks per occasion or more than 14 per week.

• For women — More then three drinks per occasion or more than seven per week.

Of course, most people underestimate the size of a drink. In class, we poured water into glasses to see if we came close to the U.S. Standard Drink Equivalent. For example, the standard-sized beer is 12 ounces, and for table wine it’s 5 ounces.

A brief screening device — RAPS4 Questionnaire — has been developed to help assess whether people have an alcohol use disorder. If someone answers yes to one of the following questions, they should get an evaluation from a professional. They are:

1. During the past year, have you had a feeling of guilt or remorse after drinking?

2. During the past year, has a friend or family member ever told you about things you said or did while you were drinking that you could not remember?

3. During the past year, have you failed to do what was normally expected from you because of drinking?

4. Do you sometimes take a drink in the morning when you first get up?

There’s was a lot of class discussion about the binge drinking that goes on among college students and knowing when a person may need professional or medical help.

You need to call an ambulance if the person:

• is continually vomiting.

• vomiting while unconscious.

• can’t be awakened or falls into an unconscious state.

• breathing irregularly.

• has an irregular, weak pulse.

• has cold, pale or bluish skin.

I've only scratched the surface on what we learned during this session. Bert Nash offers the course once a month. To learn more or to sign up, contact Lauren Grieb at lgrieb@bertnash.org or 830-1837.

The class, provided by Bert Nash Community Mental Health Center, covered: depression, suicide, anxiety, self-injury, psychosis, substance abuse and eating disorders. I learned the warning signs and symptoms and how to help.

The course was taught over four weeks. The last session, which was Sept. 28, covered eating disorders, and then there was a wrap-up of the entire course.

Eating disorders

A person with an eating disorder can be underweight, normal weight or overweight. Eating disorders are not just about food, weight, vanity or will power, but are serious and potentially life-threatening mental disorders, according to class instructors Patricia Roach Smith, chief operating officer, and Tracy Kihm, finance director.

Unlike addictions to alcohol or drugs, food can’t be given up, Kihm said.

Did you know?

• Eating disorders are two to three times more common in females than males.

• The median age of onset ranges from 18 to 20 years.

• A majority of those with an eating disorder also have another mental issue, particularly anxiety, mood disorder or substance abuse.

• Less than one-third of people with an eating disorder reported in 2007 that they had received treatment for a mental health problem in the past 12 months.

There are behavioral, physical and psychological warning signs. Among them:

• Dieting behaviors such as fasting, counting calories and avoidance of food groups.

• Evidence of binge eating such as disappearance or hoarding of food.

• Excessive, obsessive or ritualistic exercise patterns.

• Avoidance of eating meals, especially in social settings.

• Weight loss or fluctuations.

• Sensitivity to cold or feeling cold most of the time.

• Swelling around cheeks or jaw, calluses on knuckles, or dental discoloration from vomiting.

• Extreme body dissatisfaction.

• Preoccupation with food, body shape and weight.

Here’s a questionnaire for detecting eating disorders. A ‘yes’ answer to two or more indicates a likely eating disorder:

• Do you make yourself vomit because you feel uncomfortably full?

• Do you worry that you have lost control over how much you eat?

• Have you recently lost more than 12 pounds in a 3-month period?

• Do you think you are too fat, even though others say you are too thin?

• Would you say that food dominates your life?

Unfamiliar illness for most

Less than 1 percent of the population will experience anorexia or bulimia in their lifetimes.

About 3 percent of people will have a binge eating disorder in their lifetime. It’s considered a disorder if the binges occur at least twice per week over six months or more.

There were eight people, including me, in the final class session — and most said they didn’t know anyone who had suffered from an eating disorder. The class discussed how difficult it would be to approach someone who might have an eating disorder.

Little did they know that, about 20 years ago, I was among that small percentage who had anorexia. I thought I would be able to share my experience after all of these years, but I couldn’t. For me, it’s easier in writing:

• I had many of the warning signs. A few examples: I hovered over the vents to keep warm in winter, exercised a lot and avoided eating meals. I can remember my volleyball coaches coaxing me to order something besides a diet Coke after away games. I counted calories, down to the 5 in a stick of gum.

• Often people resist help, and I was one of them. I denied that I had a problem and resisted any help or advice from my parents, school counselor, school nurse, primary care doctor, two psychologists and even a fellow classmate who had suffered the same disease. (A side note: There were two other girls in my high school who suffered from anorexia, and I had a college friend who suffered from bulimia. Over the years, I have learned of other young girls who had anorexia through family and friends.)

• Eating disorders are long-term problems that aren’t easily overcome. My illness lasted for about five years with the peak being between the ages of 16 and 18.

Overview

Class members shared how they would use their Mental Health First Aid training. Everyone said they could use it in their personal and professional lives and shared specific examples.

And thanks to the class, we now have an action plan to do so:

• Access for risk of suicide or harm.

• Listen nonjudgmentally.

• Give reassurance and information.

• Encourage appropriate professional help.

• Encourage self-help and other support strategies.

Roach-Smith asked who we thought would benefit from the class. At first, occupations such as teachers, police officers, pastors and human resource professionals were named. Then, we realized anyone and everyone could benefit.